Health and Social Care

Anne Marie Morris Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

I say to the hon. Lady that, genuinely, these plans offer us an opportunity to produce a transformative process, but they are being undermined by a number of critical points, and we should address them.

[Anne Marie Morris (Newton Abbot) (Con)]

Does my hon. Friend agree that one of the key pieces missing from the STP plans is the bit that enables that double running, so that we can move from the existing system to the new system? There is no money anywhere for any transition and double running.

[Dr Wollaston]

I absolutely agree with my hon. Friend and neighbour. As she will know, in our area, we are seeing not only the closure of four much-loved community hospitals, but, on top of those 44 beds lost from community hospitals, the local trust wanting to cut 32 acute beds, at a time when its bed occupancy is already running between 92% to 94%. Unless we have that double running and the communities can genuinely see the change, those plans will be seriously undermined. Too often, the NHS plans for hoped-for demand, rather than actual demand.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

Let us be clear: estimates are a serious business; they must be realistic. Every year, Parliament votes on how much can be spent. If excess is needed, Departments have to go back to the House, so getting estimates right is mission-critical.

The challenge I have with these estimates is that I have little faith that the assumptions they are based on are realistic. As my hon. Friend the Member for Totnes (Dr Wollaston) said, there is an assumption that demand will go down. As the population increases, and as immigration increases, that seems a very unrealistic view to take. The Government need to look long and hard at the assumptions they have made, because I for one am not convinced that they have got them right.

We also need to look at what these estimates assume in terms of the negatives. They assume we can keep on course if we reduce public health spending. If we start reducing that spending, which prevents the need for NHS intervention—the most expensive form of intervention—will we really save money? It seems to me that we will not. The other assumption made in these estimates is that central administration will be cut. We should bear in mind the complexity of what is going on at the moment, with 44 STPs coming on board, as we all hope they will, and I agree with my hon. Friend that they are a good concept, although I have some real concerns about delivery. Overall, I am concerned that these estimates are not based on realistic assumptions, and Ministers will need to seriously address that.

As the hon. Member for Hackney South and Shoreditch (Meg Hillier), who leads the Public Accounts Committee, and my hon. Friend have said, the estimates must take into account what we need for health and social care. If we cut spending on social care, or do not adequately fund it, we will increase spending in the NHS.

However, underpinning all of that is the need to have measurements in place across the whole system, as my hon. Friend indicated, so that we know what the full scope of the demand is. We must measure the results achieved by the resource we put in and the outcomes for the population as a whole. We all talk about measures around A&E and the NHS. We all talk about waiting times, and the targets that are set are all around waiting times. However, nobody is looking at what impact that has on primary care—on our GPs—or on social care. If an estimate is to be right, therefore, we need to look at the whole system of measurement.

[Jo Churchill (Bury St Edmunds) (Con)]

My hon. Friend is making powerful points. At my local district general hospital, West Suffolk, winter preparedness plans included a 5% uplift in demand—this is exactly the point she is making—but there was a 20% increase. I have exactly the same thing in social care, where my social care providers tell me people are older and more poorly. We have increased demand across the piece for that reason.

[Anne Marie Morris]

I thank my hon. Friend for that helpful example. She is absolutely right.

If we look at the whole measurement system—this was acknowledged in one of our Public Accounts Committee sessions by the Department of Health—we see that there is limited measurement, and that there probably should be more. When I challenged the individual concerned on whether the Government would be looking at that, he stood from one foot to the other and could not give us much of an answer. These estimates have to be based on proper measurement of need, on what is operationally put into practice, and on the outcome for patients, but that simply is not the case.

We need to look at the differences between the NHS and social care as regards how the money is allocated. In the NHS, we have some ring-fencing, while in social care we do not, but because the two are inextricably linked, unless we look at the way in which each of those pots is managed, never mind how much is in them, we give rise to problems for the future. Social care is not ring-fenced. I am sure we are all grateful for the additional moneys that have been provided, but frankly they do not go far enough. The first chunk of money might cover the living wage, and the ability of local authorities to increase the precept by 3% is welcome, but as the Chair of the Public Accounts Committee said, that is taxpayers’ money.

[Dr Murrison]

My hon. Friend is making a very good speech. Does she share my concern about the 3% precept, as shifting the cost of health and social care away from general taxation on to a property-based tax has obvious problems—not least, that it will disadvantage communities that are less well off?

[Anne Marie Morris]

My hon. Friend makes a fair point. I have one of those constituencies where communities are not very well off. Many of the facilities that are there to provide social care are failing because we do not have the more affluent individuals who can ensure that some of our care homes, particularly nursing care homes, are alive and well. I am now down to just three for a very large constituency, and that is completely inadequate.

[Tim Loughton (East Worthing and Shoreham) (Con)]

My hon. Friend and I both have constituencies with a large proportion of elderly people. Indeed, Worthing has the highest proportion of over-85s in the whole country. This is a double whammy, because people who are over 85 tend to require a great deal more healthcare, stay in hospital for longer, and have multiple problems in hospital that cost more—we are looking after them well and need to look after them better—and the social care side when they do come out of hospital, too often delayed, is costly as well. Those are the growing pressures that the estimates appear not to take proper account of.

[Anne Marie Morris]

My hon. Friend makes an extremely good point. He is right that the cost of ageing is not adequately taken into account. The way the Government measure health outcomes is predicated on the number of births and looking at the lifespan of the population. Because people live longer in areas like my constituency in Devon, it is assumed that we therefore have better health outcomes, but that does not allow for the fact that we have a low number of live births. Many people move into our lovely area when they are much older, and so the level of improvement is small. There are some basic, fundamental flaws in the way the Government—not just this Government; it has gone on for years—estimate the need in an area. As my hon. Friend rightly says, one of the biggest challenges is age.

Integration is expected somehow to be the solution to all our problems, but there is no transition funding to allow for double running, and there are, as far as I am aware, not many pooled budgets. As we have heard, these plans make certain assumptions about the recruitment of individuals, but we cannot recruit at the level we need now, never mind what we will need for the future. There is also a lack of training in the specialisms that we are going to need. Specifically in some of our more rural areas—we have talked about the ageing population—we need more specialist generalists. That is agreed by most of the royal colleges, but it is not being put into practice. So many issues will impact on the effectiveness of integration that I doubt that it is really going to be a way forward in reducing costs. I am concerned that the integration model, while very welcome, has not been fully thought through. The barrier to its being successful is that there will be unbudgeted costs. There is no evidence for the assumption that demand will decrease, and so no evidence that integration will deliver savings. It therefore seems to me that these estimates cannot really be sound. Real cost estimates are needed.

We have failed to address the element of social care that is paid for privately. I refer here to the Dilnot report and the Care Act 2014. We are talking about how the Government’s money—the taxpayer’s money—is to be shared out between the two systems, but we should never forget that social care is means-tested as opposed to the NHS, which is free at the point of delivery. If we do not try to ensure that the necessary savings are made by individuals taking responsibility, with or without the Government stepping in, we will find that the demand on the NHS is simply too great for the system to succeed and for these estimates to be valid.